Peyronie’s disease is a condition characterized by a mild to severe curvature of the erect penis that can significantly impact sexual function. It’s important for men to understand Peyronie’s disease symptoms and diagnosis so they find the best treatment options for them.
Peyronie’s disease symptoms can include pain or curve in the penis and plaque in the penis, usually on the curved side of the penis, which appears as a lump.
The most difficult part about Peyronie’s disease is convincing men who are experiencing symptoms of the condition to see their doctor. Although men are embarrassed or uncomfortable about having a curved, often painful penis, they are not alone. Peyronie’s disease is not uncommon: it affects anywhere from 3% to perhaps 9% or more of the male population.
The diagnosis of Peyronie’s disease symptoms often can be made with minimal testing. Your physician (a urologist is the specialist you want to see) will ask you some questions about your symptoms, medical history, sexual habits, and other related questions, and conduct a physical examination. He or she will be looking for any one or more of the following indicators of Peyronie’s disease:
- Penile pain, which is more evident during erections. Not all men have pain, however
- Curvature of the penis, which may be obvious only with an erection or may be present with a flaccid penis
- Accumulation of plaque in the penis, usually on the curved side of the penis, which appears as a lump. About two-thirds of men have a lump, and it is generally about a centimeter in size and located on the upper midline of the penis.
- An indentation in the penile shaft, usually at the site of the plaque. The indentation gives the penis an hour-glass deformity
- Reduced erectile function, including loss of rigidity and/or penile buckling associated with the curved penis
- Reduction in length of the penis
As part of the diagnosis of Peyronie’s disease symptoms, your doctor will need to examine the penis in an erect position, which can be accomplished using an injection of a vasodilator drug, such as compounded Trimix (papaverine, phentolamine, or prostaglandin E1) or commercially available Edex (prostaglandin E1). This will allow your doctor to get an accurate measurement of the degree of curvature, deformity, and rigidity.
Although doctors ask men what they estimate their degree of curvature to be, research suggests men are not very accurate. For example, in a study of 81 men with Peyronie’s disease symptoms, the authors asked the men for their best estimate of curvature. More than half (54%) overestimated their degree of curvature and 26% underestimated it. Only 20% estimated their curvature within 5 degrees. (Bacal 2009) It’s important for doctors to have an accurate measurement of how much the penis is bent so they can better determine the severity of the condition, chose the most appropriate treatment, and objectively evaluate the effects of treatment.
Part of the diagnosis process will also include measurement of the length of the flaccid penis and the erect penis from the base to the tip. Again, this helps the doctor establish a baseline for treatment.
Physicians may also take x-rays or ultrasound of the penis to detect calcified lesions (calcium deposits in the fibrous tissue of the lump), which occurs in about one-third of patients who have Peyronie’s disease. This information can help you and your doctor determine which treatment to try, if any.
If your doctor diagnoses you with severe Peyronie’s disease symptoms and surgery is being considered, then he may order an ultrasound to get a clear picture of the entire extent of the plaque and to better evaluate any deformity in the penile shaft. The ultrasound, along with injections of vasoactive substances to show the arteries of the penis, can help your doctor decide which type of surgery is most suitable.
In questionable cases, doctors may order magnetic resonance imaging of the penis to see the plaque. This approach is both expensive and not always readily available, however.
Bacal V et al. Correlation of degree of penile curvature between patient estimates and objective measures among men with Peyronie’s disease. Journal of Sexual Medicine 2009 Mar; 6(3): 862-65